Patients who have grown frustrated with large health system primary care physician practices are now finding an alternative option in direct primary care.
While direct primary care has been around for some time, it is building more momentum nationally. Although still relatively small, there are currently estimated to be over 800 direct primary care practices throughout the country.
What is Direct Primary Care?
Direct primary care is an arrangement between a patient and a provider where no claims are submitted to an insurance company. Instead, the patient pays the provider directly for services. The premise of this arrangement is that an individual can save money because the physician does not have the same overhead expenses in their practice that they would otherwise have when participating in an insurance company’s provider network.
Advantages of Direct Primacy Care
Under the direct primary care model a patient pays a fixed monthly fee or pays per visit. The cost varies by provider but can be as low as $25 to $100 per month. Proponents of the direct pay model report less wait times, more time with the doctor, and overall more personal care. They believe these models provide better outcomes given the closer physician/patient relationship. Some direct primary care providers also provide patients direct access via phone or email enabling the patient to easily reach them.
Direct primary care makes the most sense for those who participate in a high deductible health plan. It is necessary to have, at a minimum, a catastrophic policy in place since direct primary care has a limited number of services that are covered.
Disadvantages of Direct Primary Care
It is also important to remember that none of the services received from a direct primary care plan will count against your insurance deductibles since the provider does not accept insurance. This could result in higher out of pocket costs since the deductible/out of pocket limits would have been satisfied under a traditional policy. Some opponents of direct primary care also argue that there is a lack of connectivity between the health system and these physicians which could impact outcomes of care.
While relatively few employers have adopted direct primary care, many are mulling it over. In these arrangements, the employer would actually pay the subscription fees on behalf of the participants. Access to direct primary care can present a challenge to some employers because it tends to work better when all of the employees live or work in one location. However, oftentimes employees do not live or work near a direct primary care provider, given only 2% of physicians currently engage in this practice.
We will continue to evaluate this option for our clients. If you want to chat with someone about direct primary care, please feel free to contact us.